The Drugs

Trigger warning: drug addiction & suicidal thoughts.

Too often, people attend their GP surgeries with complaints of pain in the body. What is the first thing many doctors do? Prescribe some painkillers and hope that it will disappear within a few weeks. When the pain doesn’t improve and common diagnoses are ruled out, stronger medication is prescribed. This cycle seemed never-ending for me. The prescriptions started off as co-codamol and ibuprofen, then increased in strength from solpadol to dihydrocodeine and eventually tramadol. This was accompanied by a trial and error system of various combinations of other medications in attempt to provide some pain relief.

It was two months before my 19th birthday when my GP decided to prescribe me tramadol. To provide some context, this is a strong opiate painkiller with highly addictive properties. It should also only be prescribed as a short-term solution for acute injuries. However, in the end, I took tramadol for six and a half years. Five of those years were on the maximum dosage of eight per day (400mg).

“Well, you’re obviously addicted” - the blunt accusatory tone from this GP echoed through the phone and still bothered me until very recently. “Sorry, what?” I replied in disbelief. Doctors are obviously extremely clever; there’s no denying that. But honestly, some have the emotional intelligence of a bloody spatula.

The day before, I had requested an urgent repeat prescription for tramadol. I was certain I had another strip of tablets, but I messed up. I didn’t have enough medication to last me over the weekend if I had to wait the normal turnaround time for a repeat prescription. This absolutely riddled me with anxiety which likely only added to my symptoms. I never needed my medication urgently so that I could get high. I simply needed it to ease my pain so that I was able to get out of bed.

I was shocked at the way this doctor spoke to me for a number of reasons. This was not my usual GP and he had never even had a single appointment with me prior to this. Additionally, it was this GP surgery who prescribed me an opioid for managing chronic pain at such a young age. Surely they should bear some responsibility in their duty of care? Finally, if I was addicted to this medication, throwing accusations around like that would certainly not be a helpful way of going about it. Regardless, I was honest with myself, and I knew that I wasn’t abusing this drug.

What followed on the phone was me (a second year biomed student) explaining to him (a qualified GP with a decade of experience) the difference between physiological dependence and psychological addiction. I still felt annoyed by this conversation years later, until I recently realised how complex and misunderstood the topic of drug addiction truly is.

To clarify (from my understanding), physiological dependence is a response where the body adapts to the drug's effects and essentially relies on it being there. This can include changes in chemical balances, hormone levels and organ functions. It will be accompanied by tolerance, where you need to increase the dosage of a drug to get the same effect. Although physical dependence is extremely common in substance abuse and can often lead to it, it is not the same. Don’t get me wrong, dependence is still very risky and will result in withdrawal symptoms if the dosage is not tapered slowly. I strongly believe that people with drug dependence should be monitored closely to prevent the development of addiction and/or accidental overdose.

As I have been writing this and fact-checking my knowledge, I experienced the recurring thought: “was I maybe actually addicted to tramadol?” I have always been adamant that I never was at any point. However, there are such blurred lines when it comes to this complicated topic that it is difficult to fully comprehend it and establish which category you fall into. The terms dependence and addiction have also been mistakenly used interchangeably which adds to the confusion.

From my understanding, addiction is a psychological disease where a user abuses a drug by taking it to get a feeling of euphoria (a ‘high') or for a reason other than its intended use. Users also often take more than what has been medically prescribed. Addiction is associated with changes in behaviour where pursuit of this drug becomes the user's main priority. After reflecting honestly on my past, I know this was never the case for me. I only ever took this medication in its prescribed dosage and for its intended purpose.

If you are reading this and you have recognised these definitions within yourself, then I strongly suggest confiding in a medical professional. You may not even think you need it, but there is no shame in reaching out for help. Dependence and addiction are extremely dangerous, and recognising there is a problem is the first step to getting your life back on track. The earlier you intervene if there are warning signs, the quicker your overall health will improve. You're not alone, and things will get better.

Something to take note of is that situations are never black and white. Experiencing this has completely altered the way I view drug addiction by becoming a lot more compassionate. I have also stopped holding anger towards the GP who accused me of being addicted to tramadol. Maybe there were some red flags for me, and he was possibly having a rough day so he lashed out. Was it helpful? No. But I hope he learned from that situation and treated patients who suffered from substance use disorders with more compassion and empathy following on from this.

Another strong medication I was prescribed was amitriptyline. This drug is classed as a tricyclic antidepressant but is also used to treat nerve pain in lower doses. I was prescribed this in order to treat sciatica which causes severe pain down the sciatic nerve. I remember feeling extremely drowsy after taking this medication, but my doctor increased my dosage anyway (still a comparatively low dose). I ended up feeling so spaced out, that looking back, I can’t even remember whether or not it truly provided pain relief. Who knows; maybe it did, or maybe I was too spaced out to even notice I was in pain. Of course medications like this come with a warning, but I rarely paid much attention to them. This was a big mistake.

One morning, I was driving down the M9 on my way to work at Prudential. I felt groggy all morning but assumed it would wear off soon. One minute, I was giving my best karaoke performance, and the next, my eyelids were becoming heavier and involuntarily closing. I then abruptly awoke to the sound and vibrations of my car drifting off the motorway over the rumble strips (was 'today years old' when I discovered the name for the bumps at the side of the motorway). Holy shit, how long was I sleeping for? The noise completely startled me; I couldn’t believe I had just fallen asleep while driving. I walked into my office feeling absolutely horrified. Shaking profusely, I was full of guilt after the traumatic realisation that I could have easily caused an accident. I was extremely lucky that I didn't.

Note to readers: warning labels are no joke! Please make sure you know how any medication affects you before getting behind the wheel.

Undoubtedly the worst side effect I have ever experienced was when taking Gabapentin. This drug is classed as an anticonvulsant and is used to treat seizures and neuropathic pain. It also takes 2-3 weeks to build up in your system before showing any benefits. However, side effects from the drug do not take this long. This is something I told only the few people closest to me about at the time as it was extremely distressing, and is still difficult for me to write about now. After around one week of taking Gabapentin, I began experiencing suicidal thoughts.

This first happened when I was taking my medication before bed one evening. I removed the tramadol I needed from the packet, but then continued filling up my hand with more and more pills. I can remember thinking I just wanted the pain to stop and I didn’t want to be here anymore. I was so angry at the world and I felt like things were never going to improve for me. I hated being a burden to everyone around me; reliant on others to do simple daily tasks. The medication made me believe that my loved ones would be better off without me. It is absolutely terrifying that a drug can result in thoughts like this. Fortunately, I snapped myself out of it and realised this wasn’t me, and I had a lot more to live for.

Another instance I can remember extremely clearly was one afternoon when I was driving. I can still picture it even though it must have been 7/8 years ago. I was heading towards Earls Gate roundabout in Grangemouth when I felt this overpowering urge to continue driving my car full speed into the roundabout. I had the same thoughts as the last time leading up to this. The main thing that deterred me was the possibility of others getting injured in the process, which obviously I didn’t want. I didn’t even truly want to hurt myself. I became extremely concerned over my mental wellbeing, but I still barely spoke to anyone about it.

Although I was suffering from depression at the time, I knew I still wanted to live. I was luckily able to distinguish between my own thoughts and side effects of the medication. I immediately made an appointment with my GP and told them I wanted taken off this medication straight away. From then, these thoughts fortunately never returned.

This blog post has taken a lot more time than the others to write. Yes, it is longer, but I have stopped and started so many times when I have found the above topics too difficult and upsetting to write about. Reliving these memories is distressing, but it’s important to talk about it and raise awareness. Every situation is temporary, and you should never choose a permanent ‘solution' to a temporary problem.

Following being involved in a road traffic accident in 2016, the impact of the collision caused a significant flare up with my pain. My GP prescribed me a drug called nortriptyline to help relieve the painful symptoms I was experiencing. This drug works in the same way as amitriptyline, which I previously would have been low on the Glasgow Coma Scale with. However, nortriptyline is not reported to have the same side effects. Why would they not just prescribe that in the first place, you ask? Nortriptyline is more expensive.

Throughout the years, I was prescribed medication which caused side effects that required additional medication to manage. Drugs to treat the side effects of drugs. For example, tramadol to treat my pain caused IBS, so I was prescribed Buscopan. Amitriptyline resulted in acid reflux, so I was prescribed Omeprazole. When taking any medication, especially for long term use, it is extremely important to weigh up the side effects with the benefits to make sure it is actually worth it.

Due to the repeated action of taking medication for so long (and also the accompanying brain fog), my body soon switched to ‘autopilot’. This was extremely dangerous as I often couldn’t remember physically taking tramadol in the morning. Because it only took the edge off my pain and the severity varied so much from day to day, it was also very difficult to identify whether I had taken any.

Consuming any more than the maximum dosage I was already taking may have caused serious toxic side effects. To prevent this, my colleague bought me a pill box with separate compartments for each day of the week. It was mainly as a joke for part of my 21st birthday present and I felt like a grandma using it, but it actually turned out to be extremely helpful. However, at some point years later, there were too many pills to fit in the box for one day. I believe this is when I thought to myself that things needed to change.

Thank you for reading :)

Much love, Kirsten xox